Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2016

Open Access 01-12-2016 | Primary research

Psychotic spectrum symptoms across the lifespan are related to lifetime suicidality among 147 patients with bipolar I or major depressive disorder

Authors: Camilla Gesi, Claudia Carmassi, Mario Miniati, Antonella Benvenuti, Gabriele Massimetti, Liliana Dell’Osso

Published in: Annals of General Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Conflicting evidence exists about the relationship between psychotic symptoms and suicidality in mood disorders. We aimed to investigate the lifetime suicidality and its relationship with dimensions of the psychotic spectrum over the lifespan among subjects with bipolar I (BD I) or major depressive disorder (MDD).

Methods

147 Consecutive out- and inpatients with BD I or MDD presenting for treatment at 11 Italian Departments of Psychiatry were administered the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY, lifetime version) and the Mood Spectrum Self-Report (MOODS-SR, lifetime version).

Results

Subjects with psychotic features did not differ from those without for MOODS-SR suicidality score. Controlling for age, gender and diagnosis (MDD/BD I), the SCI-PSY total score (p = .007) and Paranoid (p = .042), Schizoid (p = .007) and Interpersonal Sensitivity (p < .001) domain scores independently predicted lifetime MOODS-SR suicidality score in the overall sample.

Conclusions

Psychotic features, as evaluated upon the presence of delusions or hallucinations, are not associated with suicidality among subjects with BD I or MDD. However, more subtle dimensions of the psychotic spectrum, such as Interpersonal Sensitivity, Paranoid and Schizoid symptoms, show a significant relationship with lifetime suicidality. Our findings highlight the potential usefulness of a spectrum approach in the assessment of psychotic symptoms and suicide risk among subjects with BD I or MDD.
Literature
1.
World Health Organization. Preventing suicide: a global imperative. Geneva: World Health Organization; 2014.
2.
Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33:395–405.CrossRefPubMed
3.
Moscicki EK. Identification of suicide risk factors using epidemiologic studies. Psychiatr Clin North Am. 1997;20:499–517.CrossRefPubMed
4.
Vilhjalmsson R, Kristjansdottir G, Sveinbjarnardottir E. Factors associated with suicide ideation in adults. Soc Psychiatry Psychiatr Epidemiol. 1998;33:97–103.CrossRefPubMed
5.
Möller HJ. Suicide, suicidality and suicide prevention in affective disorders. Acta Psychiatr Scand Suppl. 2003;418:73–80.CrossRefPubMed
6.
Kessler RC, Berglund P, Borges G, Nock M, Wang PS. Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA. 2005;293:2487–95.CrossRefPubMed
7.
Bostwick JM, Pankratz VS. Affective disorders and suicide risk: a reexamination. Am J Psychiatry. 2000;157:1925–32.CrossRefPubMed
8.
Hawton K, Sutton L, Haw C, Sinclair J, Harriss L. Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005;66:693–704.CrossRefPubMed
9.
Nordentoft M, Mortensen PB, Pedersen CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011;68:1058–64.CrossRefPubMed
10.
Beautrais AL, Joyce PR, Mulder RT. Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry. 1997;36:1543–51.PubMed
11.
Dell’Osso L, Carmassi C, Carlini M, Rucci P, Torri P, Cesari D, et al. Sexual dysfunctions and suicidality in patients with bipolar disorder and unipolar depression. J Sex Med. 2009;6:3063–70.CrossRefPubMed
12.
Dell’Osso L, Carmassi C, Rucci P, Ciapparelli A, Paggini R, Ramacciotti CE, et al. Lifetime subthreshold mania is related to suicidality in posttraumatic stress disorder. CNS Spectr. 2009;14:262–6.PubMed
13.
Dell’Osso L, Massimetti G, Conversano C, Bertelloni CA, Carta MG, Ricca V, et al. Alterations in circadian/seasonal rhythms and vegetative functions are related to suicidality in DSM-5 PTSD. BMC Psychiatry. 2014;14:352.CrossRefPubMedPubMedCentral
14.
Dell’Osso L, Stratta P, Conversano C, Massimetti E, Akiskal KK, Akiskal HS, et al. Lifetime mania is related to post-traumatic stress symptoms in high school students exposed to the 2009 L’Aquila earthquake. Compr Psychiatry. 2014;55:357–62.CrossRefPubMed
15.
Simoncini M, Miniati M, Vanelli F, Callari A, Vannucchi G, Mauri M, et al. Lifetime autism spectrum features in a patient with a psychotic mixed episode who attempted suicide. Case Rep Psychiatry. 2014;459524.
16.
Nishida A, Sasaki T, Nishimura Y, Tanii H, Hara N, Inoue K, et al. Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12–15 years. Acta Psychiatr Scand. 2010;121:301–7.CrossRefPubMed
17.
Saha S, Scott JG, Johnston AK, Slade TN, Varghese D, Carter GL, et al. The association between delusional-like experiences and suicidal thoughts and behaviour. Schizophr Res. 2011;132:197–202.CrossRefPubMed
18.
Kelleher I, Corcoran P, Keeley H, Wigman JT, Devlin N, Ramsay H, et al. Psychotic symptoms and population risk for suicide attempt: a prospective cohort study. JAMA Psychiatry. 2013;70:940–8.CrossRefPubMed
19.
Kelleher I, Devlin N, Wigman JT, Kehoe A, Murtagh A, Fitzpatrick C, et al. Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning. Psychol Med. 2014;44:1615–24.CrossRefPubMed
20.
Kelleher I, Lynch F, Harley M, Molloy C, Roddy S, Fitzpatrick C, et al. Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Arch Gen Psychiatry. 2012;69:1277–83.CrossRefPubMed
21.
Fisher HL, Caspi A, Poulton R, Meier MH, Houts R, Harrington H, et al. Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychol Med. 2013;43:2077–86.CrossRefPubMedPubMedCentral
22.
DeVylder JE, Lukens EP, Link BG, Lieberman JA. Suicidal ideation and suicide attempts among adults with psychotic experiences: data from the Collaborative Psychiatric Epidemiology Surveys. JAMA Psychiatry. 2015;72:219–25.CrossRefPubMed
23.
DeVylder JE, Thompson E, Reeves G, Schiffman J. Psychotic experiences as indicators of suicidal ideation in a non-clinical college sample. Psychiatry Res. 2015;226:489–93.CrossRefPubMed
24.
Ran M-S, Chan CL-W, Chen EY-H, Mao W-J, Hu S-H, Tang C-P, et al. Differences in mortality and suicidal behaviour between treated and never-treated people with schizophrenia in rural China. Br J Psychiatry. 2009;195:126–31.CrossRefPubMedPubMedCentral
25.
Fialko L, Freeman D, Bebbington P, Kuipers E, Garety P, Dunn G, et al. Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial. Acta Psychiatr Scand. 2006;114:177–86.CrossRefPubMed
26.
27.
Roose SP, Glassman AH, Walsh BT, Woodring S, Vital-Herne J. Depression, delusions, and suicide. Am J Psychiatry. 1983;140:1159–62.CrossRefPubMed
28.
Grunebaum MF, Oquendo MA, Harkavy-Friedman JM, Ellis SP, Li S, Haas GL, et al. Delusions and suicidality. Am J Psychiatry. 2001;158:742–7.CrossRefPubMed
29.
Finseth PI, Morken G, Andreassen OA, Malt UF, Vaaler AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients. Bipolar Disord. 2012;14:727–34.CrossRefPubMed
30.
Ran M-S, Xiang M-Z, Li J, Huang J, Chen EY-H, Chan CL-W, et al. Correlates of lifetime suicide attempts among individuals with affective disorders in a Chinese rural community. Arch Suicide Res. 2007;11:119–27.CrossRefPubMed
31.
Park M-H, Kim T-S, Yim H-W, Jeong SH, Lee C, Lee C-U, et al. Clinical characteristics of depressed patients with a history of suicide attempts: results from the CRESCEND study in South Korea. J Nerv Ment Dis. 2010;198:748–54.CrossRefPubMed
32.
Akiskal HS, Benazzi F. Psychopathologic correlates of suicidal ideation in major depressive outpatients: is it all due to unrecognized (bipolar) depressive mixed states? Psychopathology. 2005;38:273–80.CrossRefPubMed
33.
Song JY, Yu HY, Kim SH, Hwang SS-H, Cho HS, Kim YS, et al. Assessment of risk factors related to suicide attempts in patients with bipolar disorder. J Nerv Ment Dis. 2012;200:978–84.CrossRefPubMed
34.
Pawlak J, Dmitrzak-Węglarz M, Skibińska M, Szczepankiewicz A, Leszczyńska-Rodziewicz A, Rajewska-Rager A, et al. Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders. Gen Hosp Psychiatry. 2013;35:427–32.CrossRefPubMed
35.
Leadholm AKK, Rothschild AJ, Nielsen J, Bech P, Østergaard SD. Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression. J Affect Disord. 2014;156:119–25.CrossRefPubMed
36.
Dell’Osso L, Armani A, Rucci P, Frank E, Fagiolini A, Corretti G, et al. Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002;43:69–73.CrossRefPubMed
37.
First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington DC: American Psychiatric Press, Inc; 1996.
38.
Sbrana A, Dell’Osso L, Benvenuti A, Rucci P, Cassano P, Banti S, et al. The psychotic spectrum: validity and reliability of the Structured Clinical Interview for the Psychotic Spectrum. Schizophr Res. 2005;75:375–87.CrossRefPubMed
39.
IBM CORP. RELEASED. IBM SPSS Statistics for Windows, Version 20.0. Armonk NY: IBM Corp; 2011.
40.
Klonsky ED, Oltmanns TF, Turkheimer E. Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry. 2003;160:1501–8.CrossRefPubMedPubMedCentral
41.
Engin E, Gurkan A, Dulgerler S, Arabaci L. University students’ suicidal thoughts and influencing factors. J Psychiatr Ment Health Nurs. 2009;16:343–54.CrossRefPubMed
42.
Gupta MA, Gupta AK. Cutaneous body image dissatisfaction and suicidal ideation: mediation by interpersonal sensitivity. J Psychosom Res. 2013;75:55–9.CrossRefPubMed
43.
Stepp SD, Morse JQ, Yaggi KE, Reynolds SK, Reed LI, Pilkonis PA. The role of attachment styles and interpersonal problems in suicide-related behaviors. Suicide Life Threat Behav. 2008;38:592–607.CrossRefPubMedPubMedCentral
44.
Yur’yev A, Värnik P, Sisask M, Leppik L, Lumiste K, Värnik A. Some aspects of social exclusion: do they influence suicide mortality? Int J Soc Psychiatry. 2013;59:232–8.CrossRefPubMed
45.
Séguin M, Beauchamp G, Robert M, DiMambro M, Turecki G. Developmental model of suicide trajectories. Br J Psychiatry. 2014;205:120–6.CrossRefPubMed
46.
Dell’Osso L, Dalle Luche R, Cerliani C, Bertelloni CA, Gesi C, Carmassi C. Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report. Compr Psychiatry. 2015;61:10–4.CrossRefPubMed
47.
Saarinen PI, Lehtonen J, Lonnqvist J. Suicide risk in schizophrenia: an analysis of 17 consecutive suicides. Schizophr Bull. 1999;25:533–42.CrossRefPubMed
48.
Candido CL, Romney DM. Depression in paranoid and nonparanoid schizophrenic patients compared with major depressive disorder. J Affect Disord. 2002;70:261–71.CrossRefPubMed
49.
Fenton WS, McGlashan TH, Victor BJ, Blyler CR. Symptoms, subtype, and suicidality in patients with schizophrenia spectrum disorders. Am J Psychiatry. 1997;154:199–204.CrossRefPubMed
50.
Leverich GS, Altshuler LL, Frye MA, Suppes T, Keck PE Jr, McElroy SL, et al. Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry. 2003;64:506–15.CrossRefPubMed
51.
Bolton JM, Pagura J, Enns MW, Grant B, Sareen J. A population-based longitudinal study of risk factors for suicide attempts in major depressive disorder. J Psychiatr Res. 2010;44:817–26.CrossRefPubMedPubMedCentral
52.
Teraishi T, Hori H, Sasayama D, Matsuo J, Ogawa S, Ishida I, et al. Relationship between lifetime suicide attempts and schizotypal traits in patients with schizophrenia. PLoS One. 2014;16(9):e107739.CrossRef
53.
Kato K, Mikami K, Akama F, Yamada K, Maehara M, Kimoto K, et al. Clinical features of suicide attempts in adults with autism spectrum disorders. Gen Hosp Psychiatry. 2013;35:50–3.CrossRefPubMed
54.
Takara K, Kondo T. Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: a case–control study. Ann Gen Psychiatry. 2014;13:33.CrossRefPubMedPubMedCentral
55.
Horesh N, Levi Y, Apter A. Medically serious versus non-serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics. J Affect Disord. 2012;136:286–93.CrossRefPubMed
56.
Levi-Belz Y, Gvion Y, Horesh N, Fischel T, Treves I, Or E, et al. Mental pain, communication difficulties, and medically serious suicide attempts: a case-control study. Arch Suicide Res. 2014;18:74–87.CrossRefPubMed
57.
Gvion Y, Horresh N, Levi-Belz Y, Fischel T, Treves I, Weiser M, et al. Aggression–impulsivity, mental pain, and communication difficulties in medically serious and medically non-serious suicide attempters. Compr Psychiatry. 2014;55:40–50.CrossRefPubMed
58.
Dell’Osso L, Dalle Luche R, Carmassi C. A new perspective in post-traumatic stress disorder: which role for unrecognized autism spectrum? Int J Emerg Ment Health. 2015;17:e188.
59.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: Author; 2013.
Metadata
Title
Psychotic spectrum symptoms across the lifespan are related to lifetime suicidality among 147 patients with bipolar I or major depressive disorder
Authors
Camilla Gesi
Claudia Carmassi
Mario Miniati
Antonella Benvenuti
Gabriele Massimetti
Liliana Dell’Osso
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2016
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/s12991-016-0101-7

Other articles of this Issue 1/2016

Annals of General Psychiatry 1/2016 Go to the issue

Primary research

Serum levels of brain-derived neurotrophic factor (BDNF), proBDNF and plasma 3-methoxy-4-hydroxyphenylglycol levels in chronic schizophrenia

Primary research

Psychopathology of addiction: May a SCL-90-based five dimensions structure be applied irrespectively of the involved drug?

Primary research

Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level

Primary research

Development and validation of a stock addiction inventory (SAI)

Primary research

Relationship between the lesion location of acute ischemic stroke and early depressive symptoms in Japanese patients

Erratum

Erratum to: Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study